{"title":"改良全髋关节置换术中无骨水泥髋臼重建的环点柱导向算法:至少5年随访研究。","authors":"Yong Huang, Yixin Zhou, Dejin Yang, Hao Tang, Wang Deng, Shaoyi Guo","doi":"10.1302/0301-620X.107B6.BJJ-2024-0940.R1","DOIUrl":null,"url":null,"abstract":"<p><strong>Aims: </strong>The Paprosky acetabular defect classification and associated algorithms cannot adequately guide cementless acetabular reconstruction when using porous metal augments. We aimed to introduce a rim, points, and column (RPC)-orientated cementless acetabular reconstruction algorithm, and hypothesized that patients undergoing this treatment would demonstrate satisfactory mid-term clinical and radiological outcomes.</p><p><strong>Methods: </strong>We enrolled 114 patients (119 hips) who underwent revision total hip arthroplasty between April 2014 and November 2017 by a single surgeon. A minimum five-year radiological follow-up was available for 90 hips (75.6%), with mean clinical and radiological follow-up durations of 6.8 years (SD 0.9) and 6.3 years (SD 1.9), respectively.</p><p><strong>Results: </strong>Harris Hip Scores improved from 35.4 (SD 10.2) preoperatively to 86.0 (SD 10.3) postoperatively (p < 0.001). Fixation modes included rim fixation (33 hips; 27.7%), three-point fixation without point reconstruction (42 hips; 35.3%), three-point fixation with point reconstruction (40 hips; 33.6%), and three-point fixation with pelvic distraction (four hips; 3.4%). Medial wall reconstruction was performed in 20 patients (16.8%). All acetabular components were radiologically stable. Nine-year Kaplan-Meier survival rates for periprosthetic joint infection, any reoperation, and dissatisfaction were 98.28% (95% CI 88.38 to 99.76), 94.37% (95% CI 81.93 to 98.33), and 95.10% (95% CI 84.64 to 98.50), respectively.</p><p><strong>Conclusion: </strong>Acetabular component stability in cementless acetabular reconstruction relies on rim or three-point fixation, with anterior and posterior column continuity providing essential stability. Medial wall reconstruction complements fixation in the RPC algorithm, yielding satisfactory mid-term outcomes.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"107-B 6 Supple B","pages":"15-22"},"PeriodicalIF":4.9000,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Rim-point-column-oriented algorithm in cementless acetabular reconstruction in revision total hip arthroplasty : a minimum five-year follow-up study.\",\"authors\":\"Yong Huang, Yixin Zhou, Dejin Yang, Hao Tang, Wang Deng, Shaoyi Guo\",\"doi\":\"10.1302/0301-620X.107B6.BJJ-2024-0940.R1\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Aims: </strong>The Paprosky acetabular defect classification and associated algorithms cannot adequately guide cementless acetabular reconstruction when using porous metal augments. We aimed to introduce a rim, points, and column (RPC)-orientated cementless acetabular reconstruction algorithm, and hypothesized that patients undergoing this treatment would demonstrate satisfactory mid-term clinical and radiological outcomes.</p><p><strong>Methods: </strong>We enrolled 114 patients (119 hips) who underwent revision total hip arthroplasty between April 2014 and November 2017 by a single surgeon. A minimum five-year radiological follow-up was available for 90 hips (75.6%), with mean clinical and radiological follow-up durations of 6.8 years (SD 0.9) and 6.3 years (SD 1.9), respectively.</p><p><strong>Results: </strong>Harris Hip Scores improved from 35.4 (SD 10.2) preoperatively to 86.0 (SD 10.3) postoperatively (p < 0.001). Fixation modes included rim fixation (33 hips; 27.7%), three-point fixation without point reconstruction (42 hips; 35.3%), three-point fixation with point reconstruction (40 hips; 33.6%), and three-point fixation with pelvic distraction (four hips; 3.4%). Medial wall reconstruction was performed in 20 patients (16.8%). All acetabular components were radiologically stable. Nine-year Kaplan-Meier survival rates for periprosthetic joint infection, any reoperation, and dissatisfaction were 98.28% (95% CI 88.38 to 99.76), 94.37% (95% CI 81.93 to 98.33), and 95.10% (95% CI 84.64 to 98.50), respectively.</p><p><strong>Conclusion: </strong>Acetabular component stability in cementless acetabular reconstruction relies on rim or three-point fixation, with anterior and posterior column continuity providing essential stability. Medial wall reconstruction complements fixation in the RPC algorithm, yielding satisfactory mid-term outcomes.</p>\",\"PeriodicalId\":48944,\"journal\":{\"name\":\"Bone & Joint Journal\",\"volume\":\"107-B 6 Supple B\",\"pages\":\"15-22\"},\"PeriodicalIF\":4.9000,\"publicationDate\":\"2025-06-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Bone & Joint Journal\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1302/0301-620X.107B6.BJJ-2024-0940.R1\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"ORTHOPEDICS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Bone & Joint Journal","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1302/0301-620X.107B6.BJJ-2024-0940.R1","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"ORTHOPEDICS","Score":null,"Total":0}
引用次数: 0
摘要
目的:Paprosky髋臼缺损分类及相关算法不能充分指导多孔金属增强物的无骨水泥髋臼重建。我们旨在介绍一种边缘、点和柱(RPC)导向的无骨水泥髋臼重建算法,并假设接受这种治疗的患者将表现出令人满意的中期临床和放射学结果。方法:在2014年4月至2017年11月期间,我们招募了114名患者(119髋),由一名外科医生进行了翻修性全髋关节置换术。90髋(75.6%)至少有5年的放射学随访,平均临床和放射学随访时间分别为6.8年(SD 0.9)和6.3年(SD 1.9)。结果:Harris髋关节评分从术前的35.4 (SD 10.2)提高到术后的86.0 (SD 10.3) (p < 0.001)。固定方式包括边缘固定(33髋;27.7%),无点重建的三点固定(42髋;35.3%),三点固定加点重建(40髋;33.6%),以及骨盆牵引三点固定(4髋;3.4%)。内侧壁重建20例(16.8%)。所有髋臼部件放射学稳定。假体周围关节感染、任何再手术和不满意的9年Kaplan-Meier生存率分别为98.28% (95% CI 88.38 ~ 99.76)、94.37% (95% CI 81.93 ~ 98.33)和95.10% (95% CI 84.64 ~ 98.50)。结论:无骨水泥髋臼重建中髋臼假体的稳定性依赖于边缘或三点固定,前后柱连续性提供必要的稳定性。内侧壁重建补充了RPC算法中的固定,中期结果令人满意。
Rim-point-column-oriented algorithm in cementless acetabular reconstruction in revision total hip arthroplasty : a minimum five-year follow-up study.
Aims: The Paprosky acetabular defect classification and associated algorithms cannot adequately guide cementless acetabular reconstruction when using porous metal augments. We aimed to introduce a rim, points, and column (RPC)-orientated cementless acetabular reconstruction algorithm, and hypothesized that patients undergoing this treatment would demonstrate satisfactory mid-term clinical and radiological outcomes.
Methods: We enrolled 114 patients (119 hips) who underwent revision total hip arthroplasty between April 2014 and November 2017 by a single surgeon. A minimum five-year radiological follow-up was available for 90 hips (75.6%), with mean clinical and radiological follow-up durations of 6.8 years (SD 0.9) and 6.3 years (SD 1.9), respectively.
Results: Harris Hip Scores improved from 35.4 (SD 10.2) preoperatively to 86.0 (SD 10.3) postoperatively (p < 0.001). Fixation modes included rim fixation (33 hips; 27.7%), three-point fixation without point reconstruction (42 hips; 35.3%), three-point fixation with point reconstruction (40 hips; 33.6%), and three-point fixation with pelvic distraction (four hips; 3.4%). Medial wall reconstruction was performed in 20 patients (16.8%). All acetabular components were radiologically stable. Nine-year Kaplan-Meier survival rates for periprosthetic joint infection, any reoperation, and dissatisfaction were 98.28% (95% CI 88.38 to 99.76), 94.37% (95% CI 81.93 to 98.33), and 95.10% (95% CI 84.64 to 98.50), respectively.
Conclusion: Acetabular component stability in cementless acetabular reconstruction relies on rim or three-point fixation, with anterior and posterior column continuity providing essential stability. Medial wall reconstruction complements fixation in the RPC algorithm, yielding satisfactory mid-term outcomes.
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